Yeah I don't really go nuts with SAFAs, but in this case if he had put lard in his coffee and on his potatoes in equicaloric amounts, his TC would be half of what it is. The leanness would typically affect TGs, so that's puzzling, but the same thing happened to Jack Kronk and his dipped when he cut out coconut oil. I think fructose, coconut oil and ethanol consumed alongside a high fat diet all have the potential to derange TGs simply because they are so liver-oriented. Not sure what's occurring with Bill here, but the LDL is a more pressing concern, in my opinion.

I would say that my weight was perfectly normal for the situation(s) I was involved in. Right now, I am at the heaviest but leanest I have ever been in my life. btw, thanks for all your replies NambyPamby

Back before I got sick <2004 I was always around 165-170, I have no blood tests from then. Then I got sick, and my weight before GB surgery was 139, I remember it well. Post GB surgery, I ate like a maniac and got to 18X, deployed, weight fluctuated, deployed, weight fluctuated. I was 170 or so in 2006/07. Then I sat around with knee injury and depression and ate pizzas until I was 240lbs. Then I slow carbed it(in two months lost 40+lbs), etc etc. My point is that I always had to gorge myself on crap to gain fat, and 'diet' to lose weight.

I'm using acne as a way to make a point, you douche. How else could I make that point? My doctor avoids blood tests at all cost. I also don't see what's wrong with using anecdotes : this whole website is based on anecdotes. But hey, if you don't wanna eat liver or walk around, then I guess it's bad advice.

a tsp of instant espresso (Megalia D'Oro or Ferrara) for that mocha and strong coffee flavor. http://www.amazon.com/Medaglia-DOro-Instant-Espresso-Coffee/dp/B002BTI9B0
http://www.amazon.com/FERRARA-Ferrara-Espresso-Instant-Coffee/dp/B000NL514Q/ref=sr_1_cc_2?s=home-garden&ie=UTF8&qid=1325218448&sr=1-2-catcorr

The article sez the effect should be only 6-8%. I'd still do away with the French-press & espresso, especially if I'm on Ambien. Try instant coffee, which has much less cafestol. Better yet, since u seem to have insomnia, drink instant decaf (e.g., Sanka). I honestly can't tell the difference. I also pour 2 tsps unsweetened cocoa and
http://www.hersheys.com/pure-products/hersheys-cocoa/natural-unsweetened.aspx

conciliator - it might not. but I know that some bodybuilders, especially those that take steroids, have been known to test for unbelievably whacked out lipid numbers. i'm not suggesting that creatine does what steroids do in any way, but it very well could play enough of a role that it's better to cut it out in Bill's case.

@Jack French press retains more of the oils in the coffee. Since the coffee has been roasted, it seems like those oils are probably mostly oxidized. That might cause problems? Maybe? Just throwing out an idea.

@Dean, it's not good advice. For christ's sake he recommends gelatin shakes. He makes anecdotally biased claims that whey is bad, when that has never been supported by research. Not to mention **nobody is asking about your acne**, maybe if whey screwed your lipids that would be one thing, but it did not.

Your liv enzymes don't make sense. Ur saying u had it taken out in 2005 but u still have very high AST in 2009 and 11/2010: what were your ALTs? Let me guess: they were 100+. What were ur cholesterol components in _/2009 (AST=91) and 5/2008 (AST=38)? U say this is all pre-Paleo. So what happened bet. 2008 & 2009, when u wen't doing Paleo? Did u gain wt?
When did u lose weight and was it doing VLC Paleo? U said 1Y ago. Bill, edit your post and list your height, also any other surgery/procedure u may have had, allergies, and any prescription/OTC/supplement medications ur currently taking.

Go out in nature and try to find a year round supply of six eggs daily. You can't do it now and you couldn't have done it during the ice age. Heavy cream does have lactose and protein, but even if it hadn't it still would have a different fat composition than lard, tallow, marrow or brain. Same for CO, which is also a neolithic food.

Since when did eggs become 'pseudo paleo'? Isn't heavy cream, the same sat fat found in beef and since it has 0 lactose, wouldn't that make it like a liquid burger minus the protein? And how is coconut also a 'pseudo paleo?'. Those three things are one of the primary reasons I started eating on paleo.

If u don't have a gallbladder, that could affect your fat digestion. What other organ are you missing or what othe procedure have you had. This is the problem of someone posting their results and not telling relevant history. Then we go on a wild goose chase.

I'm pretty sure eliminating the pseudo-paleo foods from your diet would improve your labs. And by that I mean all dairy, most eggs and coconut products. Maybe even some veggies (blasphemy!). People can bitch all they want about foods being natural or harmless, but their consumption is probably excessive compared to what would have been available. Less saturated, more monounsaturated fats (non-dairy animal fats). And walk more.

CM 5 grams/day, had only been taking it a week or two before the test.
No, I didnt have fatty liver before Paleo, that I know of. I used to be 240lbs(2008), got down to about 165lbs(2009), and built up to 185lbs(current). I dont have a gallbladder if that means anything.
Ill have to look at ast/alt from 2010.
I wasn't sick, not with the flu, no sore throat, nothing. I see the WBC counts too.. and platelets. I actually went to the gym AFTER the blood draw and in a fasted state hit PR's on Squat and Deadlift, and then ate after.

Well, there's the liver fat purging theory, which does make sense actually considering that most who come from the SAD have substantial liver fat stores that are released when they begin to eat real food. As for your TGs now, I don't think they are the result of SAFAs. Were I you, I would cut out all dairy and coconut fat and replace it with other fats if you must. Because your results are so out of range, pretty much any doctor won't balk at a re-test in 4 weeks.

TRH and TSH are virtally worthless in evaluating thyroid function. And one depends on the other. Some people will have a "normal" TSH but very high Rt3 and very low T3. Get the thyroid hormones tested.

I used to consume a lot of coconut milk/oil, but stopped 6 mo ago and upped the heavy cream/butter/bacon. Add back in coconut milk or no?
And i found NOV 2010 test results: TC - 202, HDL - 22, LDL - 116, Tri - 321 (BUT this was when I was doing a ZC meat only diet!)

I wish it was JUST high ldl, but its high ldl, low hdl, high TG's. Maybe, the LDL is high from the sat fat in diet, the TG's high from the same? or from FFA release from fat stores? and HDL is low bc of? I have no idea.

There's no indication that it's genetic. "I havent lost any weight, but have lost some fat % and gained some LBM. I do have some before labs, they were within 'normal' range per the test.(Over 1 year old)"

Not helpful? If it's familial he can stop worrying about butter vs coconut oil vs olive oil vs lard vs ... or other less significant details. I did not mean it in a rude way, just a reminder and to counterbalance most of the other comments which put too much faith in dietary interventions. His diet sounds pretty close balanced and ideal.

Having re-read this article 3 times, I do not see how it relates to my situation other than to prompt me to get further blood work done. Anyone care to explain their take on this article and how it applies to me????

Replace whey\casein with even more meat and therefore more fat? I fail to see how that makes any sense. I eat more veggies than anyone else that I know. And I do not eat liver because i find it absolutely disgusting(smell, texture and taste) and there is absolutely nothing in it that I do not get someplace else. Your right I should walk more, but how much will adding walking effect a 450! LDL level?

Yeah, we're gonna need more detailed info of what you've been eating. I'd be really surprised if it weren't tons of butter. Sounds like you don't have familial hypercholesterolemia, so this is completely diet-related. Don't let anyone tell you to ignore this and keep doing what you're doing. You simply can't keep an LDL pool that large from becoming oxidized.

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Answers

You are producing LDL at too high of a rate and not clearing them. I would get off creatine, reduce dairy fat, and add low to medium resistance exercise to your weight training regimen. Personally, I added 3x per week jogging and still maintain weight lifting 4x per week. Usually I jog on my rest days, and I almost always jog in a totally fasted state (like on a weekend mornings before breakfast or before dinner on weekdays).

Also, I would consider your thyroid as others here have mentioned. You may need to get a full thyroid test. Poor thyroid function can easily mess up your LDL, which brings us to our next point. I am almost certain that you have very very low LDL receptor activity. This is why your HDL is on the floor and your LDL is in the clouds. It is a vicious circle. Your diet and workout routine is strikingly similar to mine. And while I've never had LDL that high (mine is always about 160-180), we have a similar issue with the bad ratios.

Here is what I would do first if I were you:

No Creatine

Very little dairy (perhaps for a time)

Add cardio and preferably in a fasted state to specifically target and burn FFAs

Add some turmeric to your diet somehow. This has been shown to increase LDL receptor activity.

Reduce the strain by reducing the weight in your weight lifting. (For example... I was doing 5 reps of 285 twice on the bench, and using EVERY ounce of muscle and girth within me to do so. But I switched to 8-10 reps of 250 for the first set, and 8-10 reps of 200 for the second set). This is just an example for me. But I think you get the idea. To repeat my first sentence here, what I am saying is... reduce the strain by reducing the weight in your weight lifting. I am not sure if this helps with lipid numbers, but I just know that after a full year of nearly maxed out workouts, my numbers were not good at all. I posted a question about it here a while back: http://paleohacks.com/questions/75513/could-lifting-weights-to-failure-regularly-be-problematic-for-blood-lipids-due-to .

conciliator - it might not. but I know that some bodybuilders, especially those that take steroids, have been known to test for unbelievably whacked out lipid numbers. i'm not suggesting that creatine does what steroids do in any way, but it very well could play enough of a role that it's better to cut it out in Bill's case.

Having re-read this article 3 times, I do not see how it relates to my situation other than to prompt me to get further blood work done. Anyone care to explain their take on this article and how it applies to me????

I had a ton of problems on low carb paleo including low thyroid and skyhigh cholesterol (350 ldl) I was eating full fat cheese and yogurt, a couple servings a day. My doc ordered me off all dairy to help balance my hormones and my cholesterol fell back to normal before my thyroid improved at all (that was a few months of starches that eventually did the trick).
So my thyroid may have made it worse but it wasn't the major cause.

I never cut back on meat fat and kept eating plenty of beef and bacon and even cooking in coconut oil. So it was absolutely the dairy fat that caused the up and downs in my cholesterol. Some people just shouldn't eat it, like how others just can't eat gluten, nuts, eggs, shellfish, etc. because of reactions.

How much Creatine Monohydrate are you taking? That is throwing some #s off, especially your creatine and GFR. Your cholesterol #s shouldn't be affected too much by this, although your LDL could increase by as much as 10% just by taking CM. RU a bodybuilder? How long have you been on it?

Did you have fatty liver before starting Paleo? How much weight have you lost? Or how much LBM did you gain through Paleo, exercise and CM supplementation AFTER 11/2010. Your blood test in 11/2010 shows liver-related metabolic derangement. What were your ALT and AST, then (~50 or higher)? Your current liver enzymes should be much lower but your ALT is 2x your AST, common in recovering fatty liver sufferers. It should fall to about the same level as your AST.

Second, were you sick (had a flu or infection / allergies) when you took the test? Your WBCs are jiggered all over. Retest to make sure the WBCs are within range, and rule out something more serious.

Third, you have a normal platelet count but high mean platelet volume. This could again be inflammation/infection but I'd retest when you recover from a flu or infection.

Now, when you combine all these with your LDL, they do increase the risk of CVD (incl. stroke). I'd try to see if you have additional, independent risk factors of CVD (hypertension, high platelet vol, Lpa) along with inflammation markers (CRP, IL-6, Ferritin, Fibrinogen, etc.). If you have the same #s as before (incl. your WBCs, platelets) plus high CRP, ESR, Lpa, etc., I'd be very concerned.

First order of bidness:
(-1) Check your prior labs for liver enzymes to see if you had NASH.
(0) Quit CM ASAP.
(1) Retest lipids and CBC but after you're cleared of a flu or whatever you're suffering from. Add CRP, ESR, and inflammation markers as items.
(2) Take particle size test (VAP) to assess your Lpa and ApoB.
(3) If LDL is still high, have your genes mapped with 23andme and confirm your ApoE4 status. Take the result to a cardiologist along w/your new CBC / inflammation result.
(4) If CBC items r abnormal and confirmed by inflammation markers, you need to be referred to a specialist for further screening.

CM 5 grams/day, had only been taking it a week or two before the test.
No, I didnt have fatty liver before Paleo, that I know of. I used to be 240lbs(2008), got down to about 165lbs(2009), and built up to 185lbs(current). I dont have a gallbladder if that means anything.
Ill have to look at ast/alt from 2010.
I wasn't sick, not with the flu, no sore throat, nothing. I see the WBC counts too.. and platelets. I actually went to the gym AFTER the blood draw and in a fasted state hit PR's on Squat and Deadlift, and then ate after.

Your liv enzymes don't make sense. Ur saying u had it taken out in 2005 but u still have very high AST in 2009 and 11/2010: what were your ALTs? Let me guess: they were 100+. What were ur cholesterol components in _/2009 (AST=91) and 5/2008 (AST=38)? U say this is all pre-Paleo. So what happened bet. 2008 & 2009, when u wen't doing Paleo? Did u gain wt?
When did u lose weight and was it doing VLC Paleo? U said 1Y ago. Bill, edit your post and list your height, also any other surgery/procedure u may have had, allergies, and any prescription/OTC/supplement medications ur currently taking.

You need to get a complete lipid panel with the apolipoproteins & particle numbers plus genetic markers. Also you should always do your follow-up checks with the full breakdown as well. Just getting a standard profile like this leaves a lot of missing information. You have a form of hyperlipidemia that will be difficult to follow with a standard lipid profile.

Based on the remaining information, it does not appear that the 20 hour fast created any artifacts in your results, so you can assume the results are accurate unless there is more info you have not shared such as intense exercise, etc. prior to the test.

Let's say u had your gallbladder taken out in 2005. That would make sense as your liv enzymes fell to the teens in 5/2007. However, they rose to fatty liver levels in 2/2008, when you supposedly became overweight at 240 lbs. Were you overweight/obese in 2007 and in 2005 as well, when you had surgery?

If so, that's probably fatty liver due to SAD: processed carbs as shown by 192 trigs -- it's not bad but this was prior to your weight loss in 2009 via "slow carbs" (beans but no dairy), when your liv enzymes were halved. No cholesterol #s here but I trust they were normal at this time.

Your #s went bonkers in 11/2010 when you hit 320 trigs w/high liver enzymes. This was your zero-carb, meat only diet; you weren't doing dairy and non-meat SAFA like u are doing now. But your LDL wasn't bad (116). U must have had episodes of running to the bathroom, eating that much fat without the gallbladder.

In short, it seems to be Apo E4. You hit FH territory (TC>=350) with SAFA. I'd try taking out all non-meat SAFA as posted above and see how you fare. U can quickly confirm your Apo status through 23andme for $200. Also take out coffee and CM. I'd increase carbs to about 150-200g using yams, sweet potatoes, peas, and lentils, if they don't bother u. That should reduce your TC and at least turn your LDL to type A. For that to happen, though, your HDL has to go up and trigs have to go down.

If not, the only option I see is increasing carbs more. That's because you have additional issues:

Your creatinine is chronically elevated and this is not due to CM. Seems like your BP was not under control back in 2007-8: GFR of 68 when you were only 30, very similar with another poster here, Berger. U have hypertension? Your doc must've talked to you about low kidney function? Hypertension is a separate risk factor for CVD.

You have a consistently high mean platelet volume, another risk factor of CVD that affects blood clotting. I'd get tested for Lpa and Fibrinogen: they could be similarly elevated.

WBC abnormalities could just be noise but keep an eye on them, since they're more often out of the range than not when you're supposedly healthy. Ask for inflammation markers like Ferritin, CRP, IGF-1 and ANA to rule out autoimmunity and other conditions, since u r complaining of unexplained fatigue. Watch out for increased risk of colorectal cancer for those with no gallbaldder.

Very low HDL throughout, even when exercising. Like above, more cardio vs. weights, more reps vs. heavy weights. For u, trigs may not serve as a marker of insulin as it does in most people. No blood sugar issue but u seem to become hypoglycemic when fasting (back in 2007-08).

Back before I got sick <2004 I was always around 165-170, I have no blood tests from then. Then I got sick, and my weight before GB surgery was 139, I remember it well. Post GB surgery, I ate like a maniac and got to 18X, deployed, weight fluctuated, deployed, weight fluctuated. I was 170 or so in 2006/07. Then I sat around with knee injury and depression and ate pizzas until I was 240lbs. Then I slow carbed it(in two months lost 40+lbs), etc etc. My point is that I always had to gorge myself on crap to gain fat, and 'diet' to lose weight.

I would say that my weight was perfectly normal for the situation(s) I was involved in. Right now, I am at the heaviest but leanest I have ever been in my life. btw, thanks for all your replies NambyPamby

a tsp of instant espresso (Megalia D'Oro or Ferrara) for that mocha and strong coffee flavor. http://www.amazon.com/Medaglia-DOro-Instant-Espresso-Coffee/dp/B002BTI9B0
http://www.amazon.com/FERRARA-Ferrara-Espresso-Instant-Coffee/dp/B000NL514Q/ref=sr_1_cc_2?s=home-garden&ie=UTF8&qid=1325218448&sr=1-2-catcorr

@Jack French press retains more of the oils in the coffee. Since the coffee has been roasted, it seems like those oils are probably mostly oxidized. That might cause problems? Maybe? Just throwing out an idea.

The article sez the effect should be only 6-8%. I'd still do away with the French-press & espresso, especially if I'm on Ambien. Try instant coffee, which has much less cafestol. Better yet, since u seem to have insomnia, drink instant decaf (e.g., Sanka). I honestly can't tell the difference. I also pour 2 tsps unsweetened cocoa and
http://www.hersheys.com/pure-products/hersheys-cocoa/natural-unsweetened.aspx

There's no indication that it's genetic. "I havent lost any weight, but have lost some fat % and gained some LBM. I do have some before labs, they were within 'normal' range per the test.(Over 1 year old)"

Not helpful? If it's familial he can stop worrying about butter vs coconut oil vs olive oil vs lard vs ... or other less significant details. I did not mean it in a rude way, just a reminder and to counterbalance most of the other comments which put too much faith in dietary interventions. His diet sounds pretty close balanced and ideal.

In addition to getting a VAP or NMR lipid profile, I would get a complete thyroid panel done to include total T4, T4 free, T3 total, T3 free, reverse T3, TSH

I would not be surprised that you are hypothroid. Cholesterol levels are higher than normal because the body's inability to produce T4 that breaks down cholesterol when hypothroid You also need a 4x salivary cortisol test done as cortisol levels during the day give hints as to how to treat hypothroidism.

There is really nothing you can do diet wise if you are hypothroid. Get your thyroid issues straightened out and your lipid profile will be better. Many folks find they cannot do any dairy to include whey. Some fortunate ones can do all the dairy they want
with no ill effects.
Low carb diets seem to reveal hypothroid problems that were masked by the previously eaten SAD diet. This is why many people feel so [email protected] when discovering paleo and going low carb. They add back in a couple hundred grams of carbs and all is well...except for the relationship of hypothroidism and Cardio Vascular Disease.

There is a dearth of physicians that really understand how to treat thyroid problems.

You can also do Dr Kruse's Leptin Reset Protocol. He says than many thyroid problems are corrected by becoming leptin sensitive...but if the thyroid has shut down then the reset will only mildly help.

TRH and TSH are virtally worthless in evaluating thyroid function. And one depends on the other. Some people will have a "normal" TSH but very high Rt3 and very low T3. Get the thyroid hormones tested.

I'm afraid your diet isn't very airtight, Bill. Lots of omega-6 in there. Do you take any supplements?

I would definitely cut out the whey and the casein. As an anecdote : there is nothing that gives me more acne than whey and casein (especially whey). I don't see why people always take it : what's the point, really? Just eat a good steak and you'll have all the protein you need... Use gelatin if you really want a shake. You'll spend less and you'll be healthier. WIN-WIN

That being said, if you've been paleo for more than a year and haven't eaten liver or loads of vegetables, there's a good chance you got a copper deficiency. While butter might be a plausible explanation for this, I believe such a deficiency is even more plausible.

Another thing you should absolutely consider is lack of activity. My father has bad cholesterol, since he started walking a lot it has improved a lot. And his diet sucks, believe me (loads of bread, he eats constantly, ... the only thing that is good is his 5 portions of fruit).

Replace whey\casein with even more meat and therefore more fat? I fail to see how that makes any sense. I eat more veggies than anyone else that I know. And I do not eat liver because i find it absolutely disgusting(smell, texture and taste) and there is absolutely nothing in it that I do not get someplace else. Your right I should walk more, but how much will adding walking effect a 450! LDL level?

I'm using acne as a way to make a point, you douche. How else could I make that point? My doctor avoids blood tests at all cost. I also don't see what's wrong with using anecdotes : this whole website is based on anecdotes. But hey, if you don't wanna eat liver or walk around, then I guess it's bad advice.

@Dean, it's not good advice. For christ's sake he recommends gelatin shakes. He makes anecdotally biased claims that whey is bad, when that has never been supported by research. Not to mention **nobody is asking about your acne**, maybe if whey screwed your lipids that would be one thing, but it did not.

1.) THERE IS LITTLE EVIDENCE THAT ELEVATED TOTAL CHOLESTEROL IS ASSOCIATED WITH ATHEROSCLEROTIC DISEASE.
2.) A LOW HDL HAS BEEN SHOWN TO BE ASSOCIATED WITH A POORER PRGNOSIS ONLY IN INDIVIDUALS WITH PREVIOUSLH DIAGNOSED CAD.
3.) THERE IS ONLY MARGINAL EVIDENCE THAT DIETARY INTAKE OF CHOLESTEROL IS RELATED TO TOTAL OR HDL.
4.) I DONT KNOW HOW KNOWING YOUR VLDL, OR LDL WOULD PROVIDE USEFULL INFORMATION, BUT I AM LISTENING!?
5.) IF YOU ARE ANXIOUS ABOUT CHOLESTEROL DOGMA, THEN THERE IS LITTLE MAGIC HERE, DOGMA STILL SAYS LIPITOR, LOW CHOLESTEROL DIET, AND MAYBE HIGH DOSE NIACIN.

I AM GUESSING THYROTROPIN IS TSH. IF SO IT IS STONE COLD NORMAL. KNOWING T3, T4, etc WILL ADD ONLY CONFUSION.